NPAIHB COVID-19 Legislative & Policy Update
Thursday, April 9, 2020
Yesterday, April 8, the National Indian Health Board (NIHB), National Congress of American Indians (NCAI), and several area health boards, including NPAIHB, supported a letter to Senate and House leadership with proposals for the fourth COVID-19 legislative package.  The proposals are organized in four sections: (1) critical funding and access needs; (2) technical Medicaid/Medicare fixes; (3) technical amendments needed; and (4) legislative fixes and reauthorizations, including SDPI. 

NPAIHB has developed this COVID-19 legislative and policy update to keep you apprised of national and state actions in response to the novel coronavirus 2019. These updates will be posted to the NPAIHB COVID-19 website located here: 
IHS expands telehealth services during COVID-19 response
Published 4/8/20
Announces the IHS expansion of telehealth across IHS federal facilities. Six IHS sites in the Oklahoma City and Navajo Areas participated in a telehealth pilot project last week to test the Cisco Meeting system. IHS then began training IHS employees across the agency on how to use the system. IHS service units and their clinicians can now use the Cisco Meeting system. Employees at tribal and urban sites who have an IHS username and password can also use the system to provide telehealth services or consult with another provider. 

CMS COVID-19 dear clinician letter 
Posted 4/7/20
Outlines a summary of actions CMS has taken to ensure clinicians have maximum flexibility to reduce unnecessary barriers to providing patient care during the unprecedented outbreak of COVID-19. The summary includes information about tele-health and virtual visits; accelerated payments to providers and advanced payments to requesting suppliers; testing and claims reporting; and emergency waiver information.

CMS updated non-emergent, elective medical services and treatment recommendations
Posted 4/7/20
Updates CMS recommendations to postpone non-essential surgeries and other procedures to conserve critical healthcare resources and limit exposure of patients and staff to COVID-19. The recommendations include a three-tiered approach for state and local officials, clinicians, and delivery systems to consider to prioritize services and care to those who require emergent or urgent attention, manage severe disease, or avoid farms from an underlying condition.

IHS DTLL: Availability and distribution of $600 million from the CARES Act to address prevention, preparedness and response in AI/AN communities
Published 4/3/20
Announces availability and distribution decisions for $600 million in new resources appropriated from the recently enacted Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which provided $1 billion to IHS. IHS will provide $30 million to support urban Indian organizations (UIOs). IHS will allocate the remaining $570 million to IHS federal health programs and tribal health programs (THPs), using existing distribution methodologies for program increases in Hospitals and Health Clinics, Purchased/Referred Care (PRC), Alcohol and Substance Abuse, and Mental Health funding. Tribal health programs will receive these one-time, non-recurring funds through modifications to existing ISDEAA agreements. Eligible contract support costs may be added to this funding. Of the remaining $432 million, IHS will use $65 million for electronic health record stabilization and support. Decisions on the remaining #367 million are anticipated within a couple weeks. 

IHS guidance on requesting personal protective equipment (PPE) and other medical supplies from the Strategic National Stockpile (SNS) through FEMA
Issued 3/28/20
Explains that health care resources may be requested from the SNS only after other supplies and sources have been exhausted. Tribes have two options for requesting resources: (1) directly contacting their FEMA Regional Tribal Liaison; or (2) contacting their IHS Area Emergency Management Point of Contact (EMPOC). For tribes who choose to have IHS Area EMPOCs assist in their request for medical supplies will fill out the FEMA PPE Resource Request form and submit to the IHS Area EMPOC, who will then review and submit to FEMA.

Trump Administration makes sweeping regulatory changes to help U.S. healthcare system address COVID-19 patient surge
Published 3/30/20
Issues immediate temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the COVID-19 pandemic.CMS temporary actions include: (1) increase hospital capacity outside of the hospital walls; (2) rapid expansion of healthcare workforce to have physician assistants and nurse practitioners to practice to the fullest extent possible; (3) elimination of paperwork requirements and allow clinicians to spend more time with patients; and (4) further promote telehealth in Medicare. 

Coronavirus Aid, Relief, and Economic Security Act "CARES Act" 
(H.R. 748) (3rd supplemental funding package)
Signed by President 3/27/20
Provides for almost $2.2 trillion in broad funding across multiple federal sectors as part of the ongoing response to the COVID-19 outbreak. For healthcare, the CARES Act provides $150 billion for critical healthcare investment in protective personal equipment (PPE) for healthcare workers, diagnostic testing supplies, workforce training, new healthcare facilities construction, medical research, reinforcement of the Strategic National Stockpile of emergency medical supplies, and Medicare payment increases. For Indian Country, it includes $1.032 billion for IHS, $125 million with the CDC, $15 million from the HHS Public Health Service and Social Services Emergency Fund; and $15 million for Health Surveillance within SAMHSA. Also includes $8 billion in direct funding for tribal governments to cover expenditures related to tribal COVID-19 responses through the Department of Treasury. 


Governor Little outlines process to ensure transparency, accountability in use of federal funds to fight coronavirus
Published 4/7/20
Establishes a new Coronavirus Financial  Advisory  Committee to oversee the approximately $1.25 billion in federal funds that Idaho will receive to fight the COVID-19 pandemic. The Committee will make recommendations to ensure federal funds are  appropriately  prioritized and efficiently distributed across state, local and tribal governments.  The  funds are expected to be available on or around April 24. The Committee includes Councilwoman Chantel Greene, Nez Perce Tribe as the Idaho Tribal Representative. 

Governor Little suspends more rules to increase telehealth access, ease licensing for medical professionals fighting coronavirus
Released 4/2/20
Announces suspension of an additional 18 regulations to more quickly and efficiently respond to Idaho's coronavirus emergency, adding to the 125 regulations that Governor Little suspended in March. The latest actions ensure greater access to telehealth and medical professionals to more easily obtain necessary licenses.

CMS approves Idaho Section 1335 waiver
Approved 3/26/20
Approves Idaho's 1335 waiver request, granting the state flexibility for use of Medicaid services during the pandemic, effective March 1. Idaho Department of Health and Welfare (IDHW) has been authorized to temporarily suspend Medicaid fee-for-service prior authorization requirements, extend pre-existing authorizations, and suspend pre-admission screening and Annual Resident Review (PASRR) Level I and Level II assessment for 30 days. Idaho currently has the authority to rely upon provider screening performed by other State Medicaid Agencies. Additionally, it allows facilities not normally reimbursed by Medicaid to be fully reimbursed for services rendered to an unlicensed facility provided a reasonable assessment that the facility meets minimum standards. 

Governor Little issues statewide stay-home order, signs extreme emergency declaration
Issued 3/25/20
Implements a 21 day stay-home order and through an extreme emergency declaration allows the state to more effectively increase health care capacity and take steps to reduce and slow the coronavirus spread. Requires citizens to self-isolate at home and excludes healthcare, public safety and other essential workers defined in the order. If you are high-risk, avoid leaving home. Grocery stores, medical facilities, and other essential businesses as defined in the order will remain open. Employers that do not provide essential services make take all steps necessary for employees to work remotely from home.


CMS approves Oregon Section 1335 waiver
Approved 3/25/20
Approves Oregon's 1335 waiver request, granting the state flexibility in how it utilizes Medicaid services and funding to combat COVID-19. The waiver is effective March 1 and will expire once the public health emergency is lifted. The Oregon Health Authority (OHA) has been approved to temporarily suspend Medicaid fee-for-service prior authorization requirements, extend pre-existing authorizations, and suspend pre-admission screenings and Annual Resident Review (PASRR) Level I and Level II assessments for 30 days. The waiver also authorizes Oregon to temporarily enroll providers that are enrolled with other State Medicaid Agencies, and outlines criteria to reimburse out-of-state providers. It also allows facilities that don't normally provide Medicaid services to be fully reimbursed for services provided during the public health emergency, provided they meet minimum standards (i.e. psychiatric residential treatment facilities and nursing facilities).

Governor Kate Brown tightens social distancing measures, tells Oregonians to "Stay Home, Save Lives"
Released 3/23/20
Issued Executive Order 20-12, immediately directing everyone in Oregon to stay at home to the maximum extent possible. Released a list of businesses that will be temporarily closed. Requires businesses not closed by the order to implement social distancing policies in order to remain open, and requires workplaces to implement teleworking and work-at-home options when possible. All non-essential social and recreational gatherings of individuals are prohibited regardless of size, if distance is at least six feet between individuals cannot be maintained. Retail businesses closed include shopping, fitness, grooming, and entertainment. 


Governor Inslee signs health care licensing waivers and other COVID-19 related orders
Released 3/26/20
Waives requirements necessary for health care workers to remain licensed to practice in the state, including ongoing training and continuing education requirements. It is anticipated that there will be na insufficient number of available licensed healthcare providers in Washington State to meet the need as the number of people infected with COVID-19 requiring medical care increases. 

Governor Inslee announces "Stay Home, Stay Healthy" order
Published 3/23/20
Orders everyone in the state to stay home. Requires that every Washingtonian stay home unless they need to pursue an essential activity, bans all gatherings for social, spiritual and recreational purposes, and closes all businesses except essential businesses. The order was set to last for two weeks but on April 2 was extended through May 4. Governor Inslee sent a government-to-government letter to Washington tribes stating that none of the Emergency Proclamation orders apply to tribes because of sovereignty. Tribes define their own essential activity on tribal lands. 
For more information
  Laura Platero, Executive Director
Sarah Sullivan, Health Policy Analyst
(503) 228-4185